Transcript CNA prep guide2011

CNA Nephrology Exam Prep
workshop
CANNT Symposium
Toronto, Ontario
November 18-20, 2010
R. Luscombe, RN, BSN, CNeph(C)
L. Vachon, RN, BSc, GNC (C)
Overview
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CNA background
How to study
Multiple choice exams
Certification exam
Practice exam
CNA Video
Definition of Certification
Certification is the voluntary and periodic process by
which an organized professional body (CNA) confirms
that a registered nurse has demonstrated competence in a
nursing specialty by having met pre-determined
standardized criteria of that specialty.
CNA Certification Program
overview
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Only national certification program for nurses in Canada
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CNA is responsible for the overall management
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Voluntary, national nursing specialty credential
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Opportunity for RNs to demonstrate competence in a
nursing specialty at a national level
CNA Certification Program
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1st CNA Certification Program exam – Neuroscience nursing
in 1991
Nephrology Nursing Certification exam available since
1993
– Nephrology stats
• 2002 –828
• 2003 – 877
• 2004 –921
• 2005 – 963
• 2006- 1019
• 2007- 1052
• 2008- 1080
• 2010 - 1129
More than 16,000 RNs have valid certification in
19 specialties
Province/Territory 2008
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AB -123
BC -150
MB- 34
NB- 35
NL- 334
NS – 39
Total 1103
NT - *
ON - 622
PE - *
QC - 51
SK - 28
YT/NU - 0
* Information suppressed to protect privacy (one to four records)
CNA Certification Program
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In 2009 - 18 bilingual nursing specialty exams
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NEW - Medical-Surgical Nursing - 2010
Exam offered annually
Approx 2,300 nurses write exams each administration
Approx. 71 writing centres, all provinces/territories
Current administration method – paper-and-pencil
Offered in French or English
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Development of the exam
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Requires many subject matter experts from across Canada
(e.g., nephrology nurses)
National standards for the practice area - foundation for
competencies
Subject matter experts write items
Each exam question is based on a competency
Psychometric experts ensure reliability and validity of the
exam items
Final exam approval by certification specialty exam
committee
Translation of English exam into French (translation experts)
Translation committee ensures accuracy of translation
Exam administration
Eligibility
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Current registration license in Canada as a registered nurse
Letter of endorsement from supervisor or consultant in the
specialty
Meet experience and education requirements
Completion of General Application Form , submission of
applicable documents and appropriate fees
– CNA Certification Program and Application guide
• 1 800 450-5206
• Email: [email protected]
• Website : www.cna-aiic.ca , New in 2008
on-line application available
(as of Sept/08)
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CNA certified nurses can use designation after their name,
e.g.,
Florence Nightingale, RN BScN CNeph(C)
Jeanne Mance, Inf., B. Sc. Inf., CNéph(C)
Certification Renewal
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Renewal every 5 years to maintain CNA credential
Nurses can choose between writing the exam or submitting
a record of continuous learning activities earned during the
5-year term
100 CL hours required and there are guidelines to assist
candidates
Certification renewal supports the concept of continuing
competence
Continuing Competence
Enhancing continuing competence through life-long learning
is essential to professional nursing practice… (CNA Joint
Position Statement, 2004)
Individual nurses are responsible for demonstrating
commitment to continuing competence through life-long
learning, reflective practice and integrating learning into
nursing practice. (CNA Joint Position Statement, 2004)
Continuing Competence
Continuous learning requires nurses to reflect on their
competencies in relation to the changes occurring in
society and the health care environment and, as a result of
that reflection, take action to acquire and develop new
competencies. (CNA Joint Position Statement, 2004)
Studying resources to consider
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Online preparation guide – available to all eligible
candidates (exam blueprint, specialty competencies,
bibliography, sample questions) –Not a core-curriculum
Reference books - CNA bibliography good starting point
Online practice test (once eligibility established, link given
to candidate)
Mentors list - on website
Study group list and study group manual available on CNA
web-site (Register your study group with CNA)
Exam blueprint, list of competencies and bibliography
available to ALL nurses on CNA web-site
How to study
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Do prep study guide first before studying (use pencil)
Alone vs Group
– Begin and end each session with quick review
– Review notes and text- flash cards, create questions
– Ask questions (multidisciplinary team)
Develop a timeline
What concept competencies are you unfamiliar with (Tx,
Peds, PD, hemo)
Lectures (after lecture study material and review notes)
Relate knowledge to your own practice
Other resources
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Videos,
Texts,
Buddy with RN
Preparing for multiple choice
exams
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Start early – long term memory
Understand new vocabulary and key definitions
Brainstorm possible questions
Practice sample questions
Refer to CNA certification specialty competencies on a
regular basis
Example
CNeph(C) Study Group Agenda
Jan 2 – Presentation – Chronic Kidney Disease
Jan 9 – Patient Assessment Relating to Renal Failure
Jan 16 – Presentation – Anemia
Jan 23 – Acute Renal Failure/Dialysis Adequacy
Jan 30 – Chronic Renal Failure
Feb 6 – Complications of Hemodialysis
Feb 13 – Presentation – Cardiac
Feb 20 – Transplantation
Feb 27 – Transplantation
Mar 6 – Presentation – Bone and Mineral Metabolism
Mar 13 – Peritoneal Dialysis
Mar 20 – Vascular Access
Mar 27 – Pediatrics
April 2 – Pharmacology
April 10 – Wrap up
Thanks to April O’Brien and Katie Nikl
Multiple choice exams
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Cover broader range of content
Test different levels of thinking
Variety of realistic and practical situations
Easier to score
Approximately 165 – 170 questions
Stem then four possible answers
Day of the exam
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Eat breakfast
Allow enough time to get to the location
Take supplies (snack, water, pencils, erasers)
Bring identification
Go to the bathroom
Strategies for taking exams
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Positive thinking
Listen to announcements
Read instructions
Complete all forms accurately
Budget your time 3.5hrs (210min)/165questions = 1.30
min
Know the question format
Read each question carefully
Choose and record the correct answer
Helpful hints
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Cover up answers before you read the stem
Anticipate the answer before looking at options
If you see your anticipated response circle it but read the
other responses to be sure one isn’t better. Eliminate all
obvious wrong response
Erase all accidental marks on the score card
Take time to check your work before handing it in
If your response isn’t there try to eliminate responses that
may be wrong
Cross out answers that are wrong
Helpful Hints
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If you can’t answer a question in a minute or less note the
question but move on come back to it later.
Transfer all responses to the answer sheet at the same time.
Decrease risk of making silly errors
Common practice ( NOT unit specific)
Guidelines
– KDOQI
– Canadian Society of Nephrology, (CSN)
– Current material within the last 5 years
Not
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Trial practices
Experimental drugs
Strategies to eliminate possible
wrong answers
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Responses that use absolutes are less likely to be correct
Funny responses are usually wrong
All of the above is usually correct if you can verify that
more than one response is probably correct (NONE on
exam) – all the above, a&b, c& d etc are NOT on exam,
always stem and 4 possible answers.
Look for grammatical clues. If the stem ends in “an” the
responses probably starts with a vowel.
Strategies to eliminate possible
wrong answers
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The longest response is often the correct response (usually
loaded with qualifying adjectives and phrases)
For number answers eliminate the extremes consider the
middle ranges
Echo options if two responses are the opposite to each
other chances are one is correct
CNA has done an excellent job eliminating these cues
Guessing
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Always guess if there is no penalty. (no penalty on CNA
exams – so better to guess and answer the question, than to
leave blank – 0 mark for unanswered questions)
Don’t guess if your penalized.
Use hints from questions you know to answer questions
you don’t know.
Eliminate wrong answers before having to guess.
Change your answer only when your sure the correction is
correct. (very important)
Common test-taking errors
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Missed important information in the question
Misreading the question
Did not read the entire responses
Failed to identify key words
Did not relate question to information in the case study
Made assumptions (very important)
Focused on insignificant details and missed key issues
Selected more than one answer
Filled in the wrong oval on computer response sheet
Types of questions
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Knowledge
Application
Critical thinking
Knowledge
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Tests your cognitive ability to recall learned material and
to understand its meaning
Identify effects of drugs
Select correct facts, concepts, principles or procedures
15 – 25 % of questions
Knowledge Example
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In cardiopulmonary resuscitation which of the following
actions should the nurse take first?
Knowledge Example
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In cardiopulmonary resuscitation which of the following
actions should the nurse take first?
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Assess the carotid pulse
Verify that the patient is unresponsive.
Place the patient on a hard, firm surface
Implement the head-tilt, chin lift maneuver.
Knowledge Answer
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In cardiopulmonary resuscitation which of the following
actions should the nurse take first?
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Assess the carotid pulse
Verify that the patient is unresponsive.
Place the patient on a hard, firm surface
Implement the head-tilt, chin lift maneuver.
Application
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Tests your ability to apply knowledge in providing patient
care
Apply rules, methods and theories
Identify consequences
50 – 60 % of questions
Application Example
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Jamie is a 10 year old boy who received a deep laceration
to his scalp when he fell off a play structure. The nurse
assesses that Jamie's injury will require suturing by the
physician.Which one of the following interventions should
be taken by the nurse to promote tissue integrity?
Application Example
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Jamie is a 10 year old boy who received a deep
laceration to his scalp when he fell off a play structure.
The nurse assesses that Jamie's injury will require
suturing by the physician.Which one of the following
interventions should be taken by the nurse to promote
tissue integrity?
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Allow the laceration to remain open to the air until the suturing can be
completed.
After cleansing the injury, apply a sterile dressing until the suturing can
be completed.
Observe the site for 24 hours to assess the extent of injury before
preparation for suturing.
Leave the original pressure dressing in place for at least three hours to
prevent hemorrhage.
Application Answer
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Jamie is a 10 year old boy who received a deep laceration
to his scalp when he fell off a play structure. The nurse
assesses that Jamie's injury will require suturing by the
physician. Which one of the following interventions should
be taken by the nurse to promote tissue integrity?
1. Allow the laceration to remain open to the air until the suturing can be
completed.
2. After cleansing the injury, apply a sterile dressing until the suturing can be
completed.
3. Observe the site for 24 hours to assess the extent of injury before
preparation for suturing.
4. Leave the original pressure dressing in place for at least three hours to
prevent hemorrhage.
Critical Thinking
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Test your ability to interpret data
Deal with abstracts
Evaluate options
Problem solve
20 –30 % of questions
Critical thinking example
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Mrs.Carson, 70 years old, is recovering from day surgery.
She has been tolerating oral fluids. At 1600 hours, the
nurse goes into Mrs. Carson’s room to discontinue her IV
and observes her vomiting. Which of the following
interventions is the most appropriate initial action for the
nurse to take?
Critical thinking example
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Mrs.Carson, 70 years old, is recovering from day
surgery. She has been tolerating oral fluids. At 1600
hours, the nurse goes into Mrs. Carson’s room to
discontinue her IV and observes her vomiting. Which of
the following interventions is the most appropriate initial
action for the nurse to take?
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Administer an antiemetic and discontinue the IV.
Maintain the IV infusion and prepare for possible admission
Continue with discharge plans and make a home care referral.
Notify Mrs. Carson’s family that there have been complications.
Critical thinking answer
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Mrs.Carson, 70 years old, is recovering form day surgery.
She has been tolerating oral fluids. At 1600 hours, the
nurse goes into Mrs. Carson’s room to discontinue her IV
and observes her vomiting. Which of the following
interventions is the most appropriate initial action for the
nurse to take?
1.
2.
3.
4.
Administer an antiemetic and discontinue the IV.
Maintain the IV infusion and prepare for possible admission
Continue with discharge plans and make a home care referral.
Notify Mrs. Carson’s family that there have been complications
Categories
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Renal anatomy and physiology (10 questions)
Patient assessment relating to renal function ( 10
questions)
Renal disorders (30 questions)
Renal insufficiency (14 questions)
Renal replacement therapies (77 questions)
Nursing management of the Palliative Care patient (6
questions)
Nursing management of the pediatric patient (6 questions)
Pharmacology (25 questions)
Alternative therapies (3 questions)
Competencies
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Review list of competencies for nephrology nursing CNA web site,
exam prep guide
Examples
I. Renal Anatomy and Physiology
1.1 The nephrology nurse identifies normal renal anatomy including structure and
characteristics of the a) kidney, b) urinary tract, c) renal vasculature.
II. Renal disorders
3.12 The nephrology nurse identifies the stages, describes the clinical course,
implements and evaluates a plan of care in collaboration with the patient in
acute renal failure: a) initiating, b) oliguric, c) diuretic or d) recovery stage.
V. Renal Replacement Therapies
Nursing management of the hemodialysis patient.
5.22 Describes the principles of hemodialysis
Competencies
V. Nursing management of the transplant client
5.44c The nephrology nurse collects and reviews data on the potential cadaveric renal donor
with respect to diagnostic tests
VII. Nursing Management of the Pediatric Client
7.4 The nephrology nurse describes the impact of renal failure in children (e.g., nutrition,
anemia, activity, socialization, medication, bone density, etc.)
IX. Adjunctive and Complementary Therapies
9.1 The nephrology nurse is aware of the existence of alternative therapies and medications
(e.g., acupuncture, homeopathy, herbal therapy, etc.)
What do I study?
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Do practice questions
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Where are you struggling?
Where are your gaps in knowledge?
What are you unfamiliar with?
What areas of nephrology are you unfamiliar with?
Practice exam
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25questions
40 minutes
Review answers
Practice exam questions and answers are from the CNA Nephrology Nursing Certification Exam
Prep Guide, 2nd edition, 2002.
Case 1
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Mr. Smith, 34 years old, presents to the nephrology
outpatient clinic. Mr. Smith informs the nephrology nurse
that he had an arteriovenous fistula created in his left
forearm 10 days ago.
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Questions 1 to 5 refer to this case.
Question 1
What approach should be considered as conservative
management therapy for Mr. Smith?
1.
2.
3.
4.
Implement an unrestricted fluid intake.
Review his dietary potassium intake.
Initiate twice weekly hemodialysis treatments.
Implement an unrestricted protein intake.
(ANSWERS)
Question 1
(Knowledge)
1. Conservative management includes fluid restriction to
avoid fluid buildup.
2. Restricted potassium in the diet is considered part of
normal conservative management.
3. Not conservative treatment, considered active treatment
4. Low protein intake has been proven to slow down the
progression of renal failure.
Question 2
What finding is most important for the
nephrology nurse to document about the initial
assessment of Mr. Smith’s access condition?
1.
2.
3.
Patency of access
Estimation of the blood flow through the fistula.
Access recirculation test results
4.
The progression of his fistula arm exercise program.
Question 2
( Application)
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2.
3.
4.
Assessment of the bruit and thrill is essential for access
assessment.
Can only be done via invasive techniques.
Would only be done once hemodialysis has been
initiated.
Fistula arm exercising may not have started yet. Fistula
is only 10 days old. Usually starts when sutures are
removed (10-14 days).
Question 3
What assessment findings support a nursing diagnosis
of infection related to fistula creation?
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2.
3.
4.
Absence of bruit.
Redness at the suture line.
Swollen fistula arm.
Numbness in the hand of the fistula arm.
Question 3
(Application)
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2.
3.
4.
Not indicative of infection; fistula may be clotted but not
infected.
One of the cardinal manifestations of any infection.
Can normally occur postoperatively for access creations
or insertions, but not indicative that infection is present.
Not indicative of an infection, but could indicate
circulatory problems.
Question 4
Mr. Smith’s serum creatinine has increased significantly.
A decision was made, in collaboration with the
nephrologist, to begin hemodialysis within a month.
What should the nephrology nurse do?
1.
2.
3.
4.
Discuss the long-term complications of kidney disease with Mr.
Smith.
Reinforce the basic principles of hemodialysis with Mr. Smith.
Review the basic anatomy of the kidney with Mr.. Smith.
Review the pathophysiology of bone disease with Mr. Smith.
Question 4
(Application)
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2.
3.
4.
Decision has been made for hemodialysis: this sort of
discussion not appropriate at this time.
Good starting point for education related to
hemodialysis.
Not a priority at this time. Could be covered later if the
patient wants this information.
Should be addressed after the patient is comfortable with
basics of hemodialysis
Question 5
Mr. Smith asks the nephrology nurse if the changes he
has recently made in his diet have an impact on the
progression of his renal failure. What serum blood level
should the nephrology nurse analyze before discussing
Mr. Smith’s diet?
1.
2.
3.
4.
Sodium
Urea
Magnesium
Aluminum
Question 5
(Application)
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2.
3.
4.
Sodium is more an indication of fluid balance.
Urea is the waste product of protein breakdown and a
good indicator of how well the patient is controlling the
protein in his diet.
Not appropriate to monitor the conservative dietary
management of a patient.
Not appropriate for the assessment of conservative
dietary management.
Case 2
Ms. Haze, 62 years old, has been on continuous
ambulatory peritoneal dialysis (CAPD) for 3 years.
Following four episodes of peritonitis in the past 6 months,
Ms. Haze had a fistula created and is scheduled to begin
hemodialysis tomorrow.
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Questions 6 to 8 refer to this case.
Question 6
Ms. Haze has been dialyzing for 2 hours and 15 minutes
when she begins to experience chest pain, dyspnea and
visual disturbances. Which one of the following clinical
assessments should the nephrology nurse include to
determine the cause of Ms. Haze’s manifestations?
1.
2.
3.
4.
Assess the ultrafiltration rate.
Visualize the extracorporeal circuit.
Maintain the blood flow rate.
Check the dialyzer coefficient
Question 6
(Critical thinking)
1.
2.
3.
4.
Dyspnea is indicative of air embolism, not hypotension.
Therefore, ultrafiltration is not a factor.
To determine whether air is present in the system.
Blood flow rate would not be maintained with air
embolism; need to stop immediately.
The dialyzer coefficient would not affect the patient in
this way.
Question 7
When caring for Ms. Haze, what should the nephrology
nurse understand about renin secretion?
1.
2.
3.
4.
It is a result of increased pressure in the afferent arteriole.
It is a result of increased sodium concentration in the distal
tubule.
It is a result of sympathetic nervous stimulation.
It is a result of the conversion of angiotensinogen to angiotensin
I.
Question 7
(Knowledge)
1.
2.
3.
4.
It is due to decreased pressure in the afferent arteriole.
It is a result of decreased sodium concentration in the
distal tubule.
Epinephrine and norepinephrine constrict the afferent
arterioles and decrease blood flow; renin is secreted in
response to the decreased pressure.
This is an action of renin, not a stimulus that causes
renin secretion.
Question 8
Ms. Haze has been prescribed nifedipine (Adalat XL).
What should the nephrology nurse consider when
providing instructions to Ms. Haze regarding this
medication?
1.
2.
3.
4.
It is a vasoconstrictor and is substantially removed by
hemodialysis.
It is a calcium channel blocker and may decrease peripheral
vascular resistance.
It is a beta blocker and may cause postural hypotension
It is an angiotensin-converting enzyme (ACE) inhibitor with a
prolonged plasma half- life in renal failure.
Question 8
(Knowledge)
1.
2.
3.
4.
It is calcium channel blocker, not a vasodilator.
It may cause regression of left ventricular hypertrophy,
improving diastolic dysfunction.
It is a calcium channel blocker, not a beta blocker.
It is a calcium channel blocker, not an angiotensinconverting enzyme inhibitor.
Case 3
Mrs. Chin, 64 years old, had a peritoneal catheter inserted
2 weeks ago. She arrives at the home dialysis unit for
training.
Questions 9 to 13 refer to this case.
Question 9
When teaching Mrs. Chin about exit-site care, what
information should the nephrology nurse provide?
1.
2.
3.
4.
The importance of daily showers.
The use of daily antibacterial ointments.
The manifestations of exit-site infection.
Daily sterile exit-site care with povidone-iodine (Betadine
Topical Preparations)
Question 9
(Application)
1.
2.
3.
4.
Daily showers are not recommended until the site has
completely healed (4-8 weeks)
Ointments are only used if prescribed by the physician.
Patients must be aware of manifestations so that therapy
can be initiated
Exit site care need not be sterilized daily.
Question 10
What manifestations of hypovolemia should the
nephrology nurse discuss with Mrs. Chin?
1.
2.
3.
4.
Increased weight and hypotension
Decreased weight and hypertension
Bradycardia and hypertension
Tachycardia and hypotension
Question 10
(Application)
1.
2.
3.
4.
Weight loss will occur.
Hypotension will occur.
Tachycardia and hypotension will occur.
Hypotension and tachycardia will occur.
Question 11
Mrs. Chin has been started on a renal multivitamin.
Why should Mrs. Chin use this medication?
1.
2.
3.
4.
Fat-soluble vitamins are lost in the dialysate.
Vitamin deficiencies are due to poor intake.
Water-soluble vitamins are lost in the dialysate.
Vitamin deficiencies are due to decreased absorption rates.
Question 11
(Application)
1.
2.
3.
4.
Water soluble vitamins are lost in dialysate.
This is not the best answer.
Correct answer.
Vitamin deficiencies can be caused by interference with
absorption by some drugs.
Question 12
Mrs. Chin returns to the clinic for her first monthly visit.
Blood work reveals that her potassium level is
3.0mmol/L. What should the nephrology nurse do?
1.
2.
3.
4.
Ask the physician to order intraperitoneal potassium chloride.
Advise Mrs. Chin to eat more bananas and oranges.
Review the use of supplemental high-potassium foods with Mrs.
Chin.
Instruct Mrs. Chin to return for blood work in one week.
Question 12
(Application)
1.
2.
3.
4.
The nephrology nurse should report the potassium
levels, but intraperitoneal medications are an added risk.
Mrs. Chin needs to know how many oranges and
bananas to eat.
The first choice should always be to increase potassium
in the diet. The dietitian is more qualified to recommend
amounts. Need to review first.
Treatment changes need to be immediate.
Question 13
Mrs. Chin reports that she is eating well but continues to
lose weight. Her serum albumin is reported at 29g/L.
What should the nephrology nurse do initially?
1.
2.
3.
4.
Recommend protein supplements
Transfer Mrs. Chin to hemodialysis treatments.
Collect a 24 hour urine sample for protein.
Alter the peritoneal dialysis prescription.
Question 13
(Critical thinking)
1.
2.
3.
4.
If a patient cannot ingest the necessary protein, then oral
enteral supplements should be tried first.
Supplements should be tried first.
The patient most likely loses proteins across the
peritoneal membrane.
Altering the prescription will not decrease protein
losses.
Question 14
Mr. Crane, 67 years old, received a renal transplant 3
weeks ago. He asks the nephrology nurse why he must
have his blood checked so often. Which one of the
following responses would be most appropriate?
1.
2.
3.
4.
“Your cyclosporine levels need to be checked because high
levels may harm your new kidney”
“I will consult with your physician regarding a decrease in the
number of times your blood needs to be checked.”
“ Your Imuran may increase your white blood cell level”.
“ As long as your have your transplant, we will need to check
your blood frequently”.
Question 14
(Application)
1.
2.
3.
4.
Cyclosporine is potentially nephrotoxic in large doses;
monitoring is by serum blood levels.
This is inappropriate; there are standards set for blood
levels.
Incorrect information
Blood collection deceases over time.
Question 15
Kyle, 2 years old, received a cadaveric renal transplant 2
weeks ago. His serum creatinine has risen sharply and he
is febrile. Which of the following statements accurately
describes the acute rejection process for Kyle?
1.
2.
3.
4.
Acute rejection is primarily humorally mediated (B
lymphocytes). The onset is gradual.
Acute rejection is primarily humorally mediated (B
lymphocytes). The onset is sudden.
Acute rejection is primarily cellular mediated (T lymphocytes).
The onset is sudden.
Acute rejection is primarily cellular mediated (T lymphocytes).
The onset is gradual.
Question 15
(Critical thinking)
1.
2.
3.
4.
This defines hyperacute rejection.
Relates to hyperacute rejection.
Acute rejection is cellular mediated and is treatable.
Rejection is treatable, but graft may not be lost.
Question 16
Mr. Scott, 47 years old, is on peritoneal dialysis. He
states that he has swelling in his scrotum. What
condition should the nephrology nurse suspect?
1.
2.
3.
4.
Inguinal hernia.
Dialysate leak
Prostate problem
Urinary tract infection
Question 16
(Critical thinking)
1.
2.
3.
4.
Wrong position considering manifestations
Normally seen in the early stage of peritoneal dialysis.
No symptoms of prostate problems.
No symptoms of urinary problems
Question 17
Mr. Labelle, 45 years old, has been on hemodialysis for
3 months. Over the last few treatments, he reports
malaise, weakness, mental confusion, dyspnea and
peripheral edema. The nephrology nurse notes frequent
hypotension during ultrafiltration. What is the most
probable cause of these manifestations?
1.
2.
3.
4.
Hyperkalemia
Pericarditis
Pericardial effusion
Pericardial tamponade
Question 17
(Critical thinking)
1.
2.
3.
4.
Not classic manifestations of hyperkalemia (except
weakness).
Manifestations generally include chest pain, fever and
pericardial rub.
These are typical manifestations of pericardial effusion.
No rub: fluid separates pericardial membranes.
Not a typical manifestation of tamponade
Question 18
Mr. Black, 58 years old, is on continuous
ambulatory peritoneal dialysis (CAPD).His most
recent peritoneal equilibration test shows that his
peritoneal membrane has high ultrafiltration
transport characteristics. What manifestations is
he most likely to exhibit?
1.
2.
3.
4.
Problems with fluid overload
Poor appetite
Problems with dehydration
Hypotension
Question 18
(Critical thinking)
1.
2.
3.
4.
Patients with high ultrafiltration transport characteristics
have rapid absorption of glucose and dissipation of the
osmotic gradient and, therefore, problems with fluid
removal.
Patients with high ultrafiltration transport characteristics
tend to have good urea and creatinine clearance and,
therefore fewer uremic symptoms (e.g., loss of
appetite).
Have problems with fluid overload not dehydration.
Have problems with fluid overload therefore
hypertension not hypotension.
Question 19
What medical test is routinely used to determine the
suitability of an individual as a living donor for kidney
transplant?
1.
2.
3.
4.
Renal arteriography
Abdominal CT scan
Renal biopsy
Pulmonary function test
Question 19
(Knowledge)
1.
2.
3.
4.
Renal arteriogram shows whether or not the vessels of a
kidney are suitable for donation.
Abdominal scans offer no information that would help
in assessing suitability for kidney donation.
Allergy testing offers no information that would help in
assessing suitability of kidney donation.
Pulmonary function tests offer no information that
would help in assessing suitability for kidney donation.
Question 20
Mrs. Caulfield, 76 years old, has been taking naproxen
(Naprosyn) 500 mg b.i.d. for the past month to treat her
rheumatoid arthritis. Which one of the following
manifestations should lead the nephrology nurse to
suspect nephrotoxicity?
1.
2.
3.
4.
Decreased urine output
Decreased appetite
Hematuria
Increased shortness of breath.
Question 20
(Application)
1.
2.
3.
4.
Not an indicator of nephrotoxicity.
Incorrect
Is a manifestation of nephrotoxicity of naproxen.
May be due to other contributing factors.
Question 21
Mr. Fry is on peritoneal dialysis using a 2.5% solution.
During a clinic visit, he states that he needs to drink
more. His weight has decreased and he is hypotensive.
What should the nephrology nurse do?
1.
2.
3.
4.
Talk to Mr. Fry about the complications of excess fluids.
Suggest that Mr.. Fry changes the dextrose solution to 1.5% to
help decrease his thirst.
Suggest that Mr. Fry increase his kilojoules intake to increase his
weight.
Suggest that Mr. Fry decreases the number of his exchanges to
decrease output.
Question 21
(Critical thinking)
1.
2.
3.
4.
Excess fluids may cause complications, but he is thirsty
because he is dehydrated.
The higher concentration of dextrose is taking off too
much fluid, as shown by a decrease in blood pressure
and an increase in thirst.
Weight loss is caused by fluid loss.
Not a true statement.
Question 22
What statement best describes the etiology of altered red
blood cell production with renal failure?
1.
2.
3.
4.
Blood loss occurs in hemodialysis patients only.
There is a decreased stimulus for red blood cell production due to
an increase of erythropoietin
The decreased survival time of red blood cells is due to an
increase in uremic toxins
Preformed antibodies from transfusions alter red blood cell
production.
Question 22
(Knowledge)
1.
2.
3.
4.
Blood loss can be related to hemodialysis as well as
frequent blood sampling. However, blood loss is not the
cause of altered red blood cell production.
Decrease stimulus for red blood cell production is due
to a decrease, not an increase , of erythropoietin
production by the diseased kidney.
An increase in uremic toxins decreases the survival time
of red blood cells.
This statement is true about a decrease in hemoglobin
but not a decrease in production of red blood cells
Question 23
Mr. Coston, 62 years old, arrives for his regular dialysis
appointment with shortness of breath, chest pain and a
BP of 100/58 mmHg. He states that he slept in a chair
last night. His predialysis urea level is 40 mmol/L. The
nephrologist has detected a pericardial friction rub. What
should the nephrology nurse anticipate?
1.
2.
3.
4.
Consult the cardiology department and arrange for admission
before initiating hemodialysis.
Initiate aggressive hemodialysis after a chest x-ray to determine
pulmonary edema.
Initiate aggressive hemodialysis using minimal amount of
heparin sodium (Hepalean).
Delay dialysis until the electrocardiogram results are available.
Question 23
(Critical thinking)
1.
2.
3.
4.
Mr. Coston is exhibiting manifestations of pericarditis
and requires immediate hemodialysis with minimal
heparin. This could be considered later.
Hemodialysis is required. An x-ray can be done at a
later date.
Aggressive dialysis with minimal heparin is the most
important plan at this time to minimize the symptoms of
pericarditis.
An ECG is not particularly helpful to determine
pericarditis.
Question 24
What is the likely cause of metabolic acidosis in renal
failure?
1.
2.
3.
4.
The kidney’s inability to excrete hydrogen ions
Increased production of ammonia by the kidney
Excessive loss of hydrochloric acid from the stomach
Decreased rate of pulmonary respirations
Question 24
(Knowledge)
1.
2.
3.
4.
Correct answer.
Decreased production of ammonia by the kidney.
Not related to renal failure.
It is not a cause of metabolic acidosis.
Question 25
Mrs. Miller, 66 years old, was admitted to the intensive
care unit following the resection of an abdominal aortic
aneurysm. Mrs. Miller develops acute tubular necrosis.
What should the nephrology nurse consider when
explaining the oliguric phase of acute renal failure to
Mrs. Miller’s family?
1.
2.
3.
4.
It begins when the kidney is first injured.
It usually last 5 to 15 days.
The manifestations of azotemia will diminish
The most common cause of death is infection
Question 25
(Knowledge)
1.
2.
3.
4.
This is the initiating stage.
Correct information.
This is the diuretic stage.
The most common cause of death is from cardiac arrest
due to hyperkalemia.
How did you do?



Strengths
Areas of improvement
Re evaluate study plan
Resource Material

List of commonly used books:
– Danovitch, G.M. (2005) Handbook of kidney transplantation (4th
ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.
– Duagirdas, J.T., Blake, P.G.&Ing, T.S., (2007). Handbook of
dialysis (4th ed.). Philadelphia, PA: Lippencott, Williams &
Wilkins
– Lancaster, L.E. (2008). ANNA Core curriculum for nephrology
nursing (4th ed.). Pitman, NJ: American Nephrology Nurses’
Association.
– Available next year Amgen modules linked through CANNT
website.
•
Current within last 5 years
Funding


Employer
Canadian Nurses Foundation (CNF)
– Each year,two bursaries, to cover certification fees, offered for
each specialty area. Contact 613 237-2133

Government
– Provincial specific. See web sites. Contact chief nursing officer.
– See CNA web site extensive provincial lists

CANNT
– ISPD Bursary (certification and re-certification)
Perusing Baccalaureate?


Institutions offering credit for certification
Eastern Canada –
–

Dalhousie, Memorial of NF, Moncton, St Francis Xavier,
Central Canada– McMaster, Ryerson, Western Ont., Ottawa, Windsor, Laurentian, Sherbrooke,
Lakehead

Western Canada– Athabasca, Brandon, Thompson Rivers, UBC, Lethbridge, Northern BC, Sask.,
Victoria, and Okanagan College.
Recertification




100 contact hours in five years
Nephrology related
Make a plan (20 hours/yr)
Keep records
–
–
–
–
In services
Presentations
Conferences
Committees
Questions
2011 EXAM: Saturday, 9 April 2011
Application DEADLINE: 15 October, 2010
CNA Certification Program Processing Centre
E-mail: [email protected]
Phone: 1-800-450-5206
Fax: (613) 237-6684
[email protected]